1. Covering the Uninsured: Options for Reform
Alliance for Health Reform Briefing
March 2, 2009
Jack Ebeler

2. Overview
Purpose: provide simple, top-line overview of approaches to coverage
Source for presentation:
Approaches for Covering the Uninsured: A Guide
by Jennifer Tolbert, Jack Ebeler, Tanya Schwartz
Kaiser Commission on Medicaid and the Uninsured
December 2008
Note: purpose was to address coverage: did not deal with cost, quality, other issues

3. Sources of health insurance coverage, individuals under age 65, by family income, 2007
As family income increases, the likelihood of:
Employment-based coverage increases
Public coverage decreases
Individual coverage is fairly constant
Being uninsured decreases
Note: over 65 not on chart; essentially all are in Medicare

4. Overview Overall approaches Build on current financing approaches
Substantially replace current approaches
Within either, attend to access to and affordability of coverage
Mix and match from menu

5. Overall: strengthen/build on current approaches
Overall approaches
Employment-based coverage:
Employer mandate – require employer to offer/subsidize
“Pay or play” – require employer to offer/subsidize, or pay to pool to finance alternative coverage source
Public coverage:
Expand Medicaid/CHIP enrollment, and/or eligibility
Medicare for those age 55-64
Subsidize benefits for temporarily unemployed
Individual coverage: revise regulatory approaches
Individual mandate option w/in any of these arrangements

6. Overall: substantially replace current financing and tax subsidies
Single payor (eg, Medicare for all)
Redirect tax subsidy away from employment-based coverage and provide directly to individuals: tax credits for individual market

7. Availability/affordability/subsidy approaches within overall framework
Affordability/subsidies
Subsidies (tax, other) for individuals and/or employers
Offer/encourage products with less expensive premiums (high deductible)
Young adult plans
Reinsurance
Availability of products/market organization
Access to/organization of larger purchasing pools (eg., connector; FEHB)
Medicare-like plan available as an option
Association health plans
High risk pools

8. Mix and match
If Congress does not go for one “pure” model, multiple combinations possible – can mix and match from the menu:
McCain
Obama campaign
Baucus
Wyden
And…

9. Thank you